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Emergency management of asthma in children: impact of NIH guidelines
1Section of Allergy/Immunology, Loyola University Medical Center, Maywood, Illinois.
Insights
The National Institutes of Health (NIH) asthma guidelines have significantly improved emergency care for children. Physicians now more frequently use advanced treatments like pulmonary function testing and corticosteroids for childhood asthma management.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Medicine
- Clinical Practice Guidelines
Background:
- Childhood asthma is a prevalent chronic condition.
- National Institutes of Health (NIH) guidelines for asthma were published in 1991.
- The impact of these guidelines on clinical practice remains understudied.
Purpose of the Study:
- To evaluate the influence of NIH asthma guidelines on the emergency management of pediatric asthma patients in the U.S.
- To assess changes in clinical practices following the guideline dissemination.
Main Methods:
- A survey was distributed to 234 Directors of Pediatric Emergency Medicine.
- The survey included questions from a 1988 study and a new question on NIH guideline impact.
- Data from 137 (59%) completed surveys were analyzed.
Main Results:
- Increased use of pulmonary function testing (73% vs. 47% in 1988, P < .001).
- Widespread adoption of inhaled beta-agonists as first-line treatment (98% vs. 17%, P < .001).
- Earlier administration of corticosteroids is now common (82% vs. 21%, P < .001).
- 50% of participants reported guideline influence on their practice.
Conclusions:
- The emergency management of childhood asthma has seen substantial positive changes since the NIH guidelines were introduced.
- These findings suggest effective guideline implementation in pediatric emergency settings.
Background:
Asthma is the most common chronic disease of childhood. In 1991 the National Institutes of Health (NIH) published guidelines for the diagnosis and management of asthma, yet little is known about their impact on clinical practice.
Objective:
To examine the impact of the NIH guidelines on the emergency management of asthmatic children in the United States.
Methods:
A short anonymous survey concerning the emergency management of childhood asthma was mailed to 234 Directors of Pediatric Emergency Medicine in all Pediatric Residency Training Programs in the United States. The survey consisted of questions originally used in a similar study conducted in 1988 and an additional question relating to the impact of the NIH guidelines.
Results:
One hundred and thirty-seven (59%) completed surveys were returned. Compared with the results of the 1988 survey, more physicians routinely use pulmonary function testing (73% versus 47% in 1988, P < .001), inhaled beta-agonists as the initial drug of choice (98% versus 17%, P < .001), and early corticosteroid administration (82% vs 21%, P < .001) in their emergency management of asthmatic children. Fifty percent of survey participants believe that NIH guidelines changed their emergency management of childhood asthma.
Conclusions:
Significant changes in the emergency management of asthmatic children have occurred since the publication of the NIH guidelines.